2Information and form of words for private health information statement—all policies

2 Information and form of words for private health information statement—all policies

For paragraph 12 (1) (a) of these Rules, the information and form of words are set out in the following table:

<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><thead><tr><td colspan="2" style="border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableHeading" style="text-align:center"><span>Information and form of words for private health information statement—all policies</span></p></td></tr><tr><td style="width:8.58%; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableHeading"><span>Item</span></p></td><td style="width:91.42%; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableHeading"><span>Information and form of words</span></p></td></tr></thead><tbody><tr><td style="width:8.58%; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="Tabletext"><span>1</span></p></td><td style="width:91.42%; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableHeading"><span>Policy name</span></p><p class="Tabletext"><span>The name of the policy.</span></p><p class="notemargin"><span>Note:</span><span style="width:15.45pt; text-indent:0pt; display:inline-block"> </span><span>See rules</span><span> </span><span>11H and 11J for rules governing the naming of policies that cover hospital treatment and the naming of policies that cover general treatment.</span></p><p class="Tabletext"><span></span></p></td></tr><tr><td style="width:8.58%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="Tabletext"><span>2</span></p></td><td style="width:91.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableHeading"><span>Name of private health insurer</span></p><p class="Tabletext"><span>The trading or brand name of the private health insurer in the State in which the policy is being made available, together with any associated branding that the insurer elects to include.</span></p><p class="Tabletext"><span></span></p></td></tr><tr><td style="width:8.58%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="Tabletext"><span>3</span></p></td><td style="width:91.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableHeading"><span>Disclaimer for restricted access insurers</span></p><p class="Tabletext"><span>If the policy is offered by a restricted access insurer—the following statement:</span></p><p class="Tabletext" style="margin-left:36pt"><span>“Membership of this insurer is restricted to”</span></p><p class="Tabletext"><span>followed by the details.</span></p><p class="Tabletext"><span></span></p></td></tr><tr><td style="width:8.58%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="Tabletext"><span>4</span></p></td><td style="width:91.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableHeading"><span>Contact details</span></p><p class="Tabletext"><span>A contact phone number and website address of the private health insurer.</span></p><p class="Tabletext"><span></span></p></td></tr><tr><td style="width:8.58%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="Tabletext"><span>5</span></p></td><td style="width:91.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableHeading"><span>State/s available in</span></p><p class="Tabletext"><span>The States in which the product is available, expressed as either:</span></p><p class="Tablea"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:10.7pt; text-indent:0pt; display:inline-block"> </span><span>if:</span></p><p class="Tablei"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(i)</span><span style="width:21.16pt; text-indent:0pt; display:inline-block"> </span><span>the product is offered in all States; and</span></p><p class="Tablei"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(ii)</span><span style="width:18.38pt; text-indent:0pt; display:inline-block"> </span><span>every feature of the product (including the monthly premium referred to in</span><br><span style="width:7.1pt; text-indent:0pt; display:inline-block"></span><span style="width:23.5pt; text-indent:0pt; display:inline-block"></span><span>item</span><span> </span><span>6) is the same in each State;</span></p><p class="Tablea"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span style="width:21.8pt; text-indent:0pt; display:inline-block"></span><span>“All States”; or</span></p><p class="Tablea"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:10.14pt; text-indent:0pt; display:inline-block"> </span><span>otherwise—the State or States in which the product is available, expressed as</span><br><span style="width:21.8pt; text-indent:0pt; display:inline-block"></span><span>whichever of the following is applicable:</span></p><p class="Tablei"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(i)</span><span style="width:21.16pt; text-indent:0pt; display:inline-block"> </span><span>“NSW &amp; ACT”;</span></p><p class="Tablei"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(ii)</span><span style="width:18.38pt; text-indent:0pt; display:inline-block"> </span><span>“Northern Territory”;</span></p><p class="Tablei"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(iii)</span><span style="width:15.6pt; text-indent:0pt; display:inline-block"> </span><span>“Queensland”;</span></p><p class="Tablei"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(iv)</span><span style="width:16.16pt; text-indent:0pt; display:inline-block"> </span><span>“South Australia”;</span></p><p class="Tablei"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(v)</span><span style="width:18.94pt; text-indent:0pt; display:inline-block"> </span><span>“Tasmania”;</span></p><p class="Tablei"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(vi)</span><span style="width:16.16pt; text-indent:0pt; display:inline-block"> </span><span>“Victoria”;</span></p><p class="Tablei"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(vii)</span><span style="width:13.38pt; text-indent:0pt; display:inline-block"> </span><span>“Western Australia”.</span></p><p class="Tablei"><span></span></p></td></tr><tr><td style="width:8.58%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="Tabletext"><span>6</span></p></td><td style="width:91.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableHeading"><span>Monthly premium</span></p><p class="Tabletext"><span>The total monthly premium payable before any rebate, loading or discount is applied.</span></p><p class="Tabletext"><span>The following words must be inserted before or following the premium amount: “before any rebate, loading or discount”.</span></p><p class="notemargin"><span>Note:</span><span style="width:15.45pt; text-indent:0pt; display:inline-block"> </span><span>This item does not limit the information that a private health insurer may give to an insured person with regard to the premium payable after any rebate, loading and/or discount is applied.</span></p><p class="Tabletext"><span style="font-weight:bold"></span></p></td></tr><tr><td style="width:8.58%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="Tabletext"><span>7</span></p></td><td style="width:91.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableHeading"><span>Corporate products</span></p><p class="Tabletext"><span>If the policy is part of a corporate product—a statement to that effect, indicating either of the following, with the bracketed text replaced with the appropriate information:</span></p><p class="Tablea"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:10.7pt; text-indent:0pt; display:inline-block"> </span><span>“Employees/members of [Company/Organisation]”;</span></p><p class="Tablea"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:10.14pt; text-indent:0pt; display:inline-block"> </span><span>“Employees/members of organisations with arrangements with this health insurer”.</span></p><p class="Tablea"><span></span></p></td></tr><tr><td style="width:8.58%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="Tabletext"><span>8</span></p></td><td style="width:91.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableHeading"><span>Closed products</span></p><p class="Tabletext"><span>If the policy is closed so that it is no longer available to anyone except those persons who, at the time of closing, were insured under the policy—the following words:</span></p><p class="Tabletext" style="margin-left:36pt"><span>“This policy is closed to new members.”.</span></p><p class="Tabletext" style="margin-left:36pt"><span></span></p></td></tr><tr><td style="width:8.58%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="Tabletext"><span>9</span></p></td><td style="width:91.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableHeading"><span>Who is covered</span></p><p class="Tabletext"><span>The insured groups that may be covered, expressed as whichever of the following is applicable:</span></p><p class="Tablea"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:10.7pt; text-indent:0pt; display:inline-block"> </span><span>“only one person”;</span></p><p class="Tablea"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:10.14pt; text-indent:0pt; display:inline-block"> </span><span>“2 adults (and no</span><span>‑</span><span>one else)”;</span></p><p class="Tablea"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(c)</span><span style="width:10.7pt; text-indent:0pt; display:inline-block"> </span><span>“2 or more people, none of whom is an adult”;</span></p><p class="Tablea"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(d)</span><span style="width:10.14pt; text-indent:0pt; display:inline-block"> </span><span>“2 or more people, only one of whom is an adult”;</span></p><p class="Tablea"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(e)</span><span style="width:10.7pt; text-indent:0pt; display:inline-block"> </span><span>“3 or more people, only 2 of whom are adults”;</span></p><p class="Tablea"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(f)</span><span style="width:11.81pt; text-indent:0pt; display:inline-block"> </span><span>“3 or more people, at least 3 of whom are adults”.</span></p><p class="notemargin"><span>Note 1:</span><span style="width:8.7pt; text-indent:0pt; display:inline-block"> </span><span>The insured groups are set out in rule</span><span> </span><span>5 of these Rules.</span></p><p class="notemargin"><span>Note 2:</span><span style="width:8.7pt; text-indent:0pt; display:inline-block"> </span><span>This item does not limit the information that a private health insurer may give to an insured person with regard to the name/s of person/s covered by the policy.</span></p><p class="Tablea"><span></span></p></td></tr><tr><td style="width:8.58%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="Tabletext" style="page-break-after:avoid"><span>10</span></p></td><td style="width:91.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableHeading"><span>Ambulance cover</span></p><p class="Tabletext"><span>The following information:</span></p><p class="Tablea"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:10.7pt; text-indent:0pt; display:inline-block"> </span><span>whether ambulance cover is included;</span></p><p class="Tablea"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:10.14pt; text-indent:0pt; display:inline-block"> </span><span>if so:</span></p><p class="Tablei"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(i)</span><span style="width:21.16pt; text-indent:0pt; display:inline-block"> </span><span>the waiting period (if any); and</span></p><p class="Tablei"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(ii)</span><span style="width:18.38pt; text-indent:0pt; display:inline-block"> </span><span>whether the cover is:</span></p><p class="TableAA"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span style="width:19.25pt; text-indent:0pt; display:inline-block"></span><span>(A)</span><span style="width:22.12pt; text-indent:0pt; display:inline-block"> </span><span>emergency only; or</span></p><p class="TableAA"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span style="width:19.25pt; text-indent:0pt; display:inline-block"></span><span>(B)</span><span style="width:22.67pt; text-indent:0pt; display:inline-block"> </span><span>emergency and non</span><span>‑</span><span>emergency; and</span></p><p class="Tablei"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(iii)</span><span style="width:15.6pt; text-indent:0pt; display:inline-block"> </span><span>any limits on cover (dollar amount or service); and</span></p><p class="Tablei"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(iv)</span><span style="width:16.16pt; text-indent:0pt; display:inline-block"> </span><span>any call</span><span>‑</span><span>out fees (if applicable);</span></p><p class="Tablea"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(c)</span><span style="width:10.7pt; text-indent:0pt; display:inline-block"> </span><span>for each State in which:</span></p><p class="Tablei"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(i)</span><span style="width:21.16pt; text-indent:0pt; display:inline-block"> </span><span>the product is available; and</span></p><p class="Tablei"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(ii)</span><span style="width:18.38pt; text-indent:0pt; display:inline-block"> </span><span>ambulance cover is not included;</span></p><p class="Tablea"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span style="width:21.8pt; text-indent:0pt; display:inline-block"></span><span>the following information:</span></p><p class="Tablei"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(iii)</span><span style="width:15.6pt; text-indent:0pt; display:inline-block"> </span><span>whether free ambulance services are available in that State;</span></p><p class="Tablei"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(iv)</span><span style="width:16.16pt; text-indent:0pt; display:inline-block"> </span><span>if so—whether they are limited to services in that State;</span></p><p class="Tablea"><span style="width:14.2pt; text-indent:0pt; display:inline-block"></span><span>(d)</span><span style="width:10.14pt; text-indent:0pt; display:inline-block"> </span><span>if ambulance cover were to be provided by a person other than the private health</span><br><span style="width:21.8pt; text-indent:0pt; display:inline-block"></span><span>insurer who prepared the statement—whether the policy would provide a benefit for</span><br><span style="width:21.8pt; text-indent:0pt; display:inline-block"></span><span>that cover.</span></p><p class="Tablea"><span></span></p></td></tr><tr><td style="width:8.58%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="Tabletext"><span>11</span></p></td><td style="width:91.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableHeading"><span>Date available</span></p><p class="Tabletext"><span>If, and only if, the policy is not yet available—the date from which the policy will be available.</span></p><p class="Tabletext"><span></span></p></td></tr><tr><td style="width:8.58%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="Tabletext"><span>12</span></p></td><td style="width:91.42%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableHeading"><span>Date statement issued or updated</span></p><p class="Tabletext"><span>The date on which the content of the statement was issued or updated, in the following format, with the bracketed text replaced with the appropriate information:</span></p><p class="Tabletext" style="margin-left:36pt"><span>“Date statement [issued/updated]: [dd]/[month in words]/[yyyy]”</span></p><p class="Tabletext"><span></span></p></td></tr><tr><td style="width:8.58%; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="Tabletext"><span>13</span></p></td><td style="width:91.42%; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableHeading"><span>Unique identifier</span></p><p class="Tabletext"><span>The unique identifier for the private health information statement that is generated by the privatehealth.gov.au system.</span></p><p class="Tabletext"><span></span></p></td></tr></tbody></table>